Research Abstracts Online
January 2009 - March 2010

University of Minnesota Twin Cities
School of Public Health
Division of Health Policy and Management

PI: David J. Knutson

Research Into Aspects of Medicare and Medicaid

These researchers are involved in three projects concerning aspects of Medicare and Medicaid. In the first, the group is analyzing Relative Resource Use (RRU) measures. These measures, developed by the National Commission on Quality Assurance (NCQA), are the first standardized measures that define efficiency of health plans. RRUs measure total annual resource use using standard prices for cohorts of individuals who are in a HEDIS quality performance measure denominator population for six chronic condition categories: diabetes, cardiovascular diseases, chronic obstructive pulmonary disease, uncomplicated hypertension, asthma, and low back pain. They can be combined with measures of quality from the Healthcare Effectiveness Data and Information Set (HEDIS). The group has obtained two years of Medicare health plan submitted HEDIS RRU performance measures as well as related HEDIS quality measures. Using MSI resources, they analyzed their internal consistency, year to year stability, health plan characteristics, regional differences, and the relationship of health plan quality performance with resource use. They are continuing to use MSI to conduct further analyses of these data including condition-specific analyses of health care quality and resource use and developing composite cost/quality measures.

The second project’s goal is to determine the feasibility of using social network methods to identify provider groups that could serve as Accountable Care Organizations (ACOs). Large organizations consist of smaller units (clinics, departments), which are the primary building blocks of organizations. Medical groups, for example, consist of primary care and specialty clinics that are assembled into a common organization. The premise of the project is that claims data can be used to identify Accountable Primary Care Groups (APCGs) of 4 to 8 primary care physicians and that APCGs can be grouped into Accountable Primary Care Systems (APCSs) of 80 to 120 physicians. This project seeks to create a methodology, based in social network approaches, to use health care claims data to identify APCGs by grouping clusters of 4 to 8 primary care physicians who provide care to a common set of patients ("shared patients”). After this identification, the methodology would group clusters of 10 to 15 APCGs into APCSs on the basis of affiliation with a common set of hospitals and specialists.

The third project explores approaches to identify and depict variation in care for Medicare beneficiaries that may further enable value-based purchasing. In addition to investigating new methods of evaluating resource use, this project also explores how potential new views of resource use might be coupled to related measures of quality providing an additional perspective of value. For this project MSI resources are used to conduct analysis on administrative data from the Centers for Medicare and Medicaid Services on health care quality and resource use data for ten states to inform the development of resource use measures.